Book: You Gotta Laugh

READ ALL ABOUT IT: “You Gotta Laugh: Life in the Trenches of the Health Insurance Industry”

Having spent more than two decades working in the health insurance industry — trying to balance the demands of health insurance providers and the needs of her clients — we couldn’t hold it on any more. We simply had to share our experience of the good, bad and the painful when it comes to settling claims and making sure every American she meets has decent health insurance.

So we have begun writing “You Gotta Laugh: Life in the Trenches of the Health Insurance Industry.”

We gotta tell you, much of what we’ve seen has been bad and painful — but here and there we’ve seen glimmers of light and hope. And that’s what you’ll find in our book — information on the problems, some solutions, ideas on how you can better traverse the insurance system, and what we’d do if we were the Health Insurance Ambassadors.

Our goal is to leave this industry in better shape than we found it. And in the chapters of this book, we hope to take a stab at doing just that.

The book also shares the real life stories of individuals that have battled the health insurance companies. We are venturing to guess that their dramas will sound familiar.

Here’s to making the world a better place — one health insurance story at a time. Scroll down to read the first chapters of the book.

Stephanie Cohen, stephanie@golden-cohen.com
Scott Golden, scott@golden-cohen.com

Having spent more than two decades working in the health insurance industry — trying to balance the demands of health insurance providers and the needs of her clients — we couldn’t hold it on any more. We simply had to share our experience of the good, bad and the painful when it comes to settling claims and making sure every American she meets has decent health insurance.

So we have begun writing “You Gotta Laugh: Life in the Trenches of the Health Insurance Industry.”

We gotta tell you, much of what we’ve seen has been bad and painful — but here and there we’ve seen glimmers of light and hope. And that’s what you’ll find in our book — information on the problems, some solutions, ideas on how you can better traverse the insurance system, and what we’d do if we were the Health Insurance Ambassadors.

Our goal is to leave this industry in better shape than we found it. And in the chapters of this book, we hope to take a stab at doing just that.

The book also shares the real life stories of individuals that have battled the health insurance companies. We are venturing to guess that their dramas will sound familiar.

Here’s to making the world a better place — one health insurance story at a time. Scroll down to read the first chapters of the book.

Stephanie Cohen, stephanie@golden-cohen.com
Scott Golden, scott@golden-cohen.com

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This month’s issue health insurance nightmare: What do you do when you have it in writing from your insurance company that you have maternity coverage — but when you go to use the benefit, the customer service department tells you otherwise?

The situation: When our client Randy, a nurse, found out a few years ago that she was having her first baby she was thrilled. Immediately, she called the insurance company to confirm her pregnancy benefits, for this is always what you should do prior to having any major test, ongoing therapies or any surgery.

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This month’s health insurance nightmare: Avoiding the mistake of not having continuity of coverage.

The situation: Our client, Ian, who worked for a nonprofit in DC from December 2007 through the end of June 2008, never thought about tracking the insurance he had from his employer and was surprised when he was required to provide his new insurer with proof of coverage. When he took another job in 2009 and applied for health insurance coverage, he called his old insurance company only to find there was no record of his previous coverage — and that’s when he called us.

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This month’s health insurance nightmare: You believe the cost of your policy is too high and the benefits are too low? But is that true?

The situation: Sara Evans was recently referred to Golden & Cohen by her friend, Susan, who has been a client of ours for years. She heard we were great advocates for our clients and sticklers about explaining the policy to the customer before they spend a penny. Sara wanted options because she was concerned that her current policy cost too much and covered too little. A case in point was a recent eye exam. She had to pay for the appointment because she hadn’t yet met the $1000 deductible on her current policy.

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This month’s health insurance nightmare: Dad is still paying for his daughter’s insurance — and no one is happy.

The situation: We received a call last week from a client whose daughter recently told him she hates her insurance “because it does not cover anything.” He phoned me to see if she had a real gripe, and if I could help him find another policy with better coverage for her.

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This month’s health insurance nightmare: You submit your health insurance payments through a third party administrator, but the administrator does not remit payments to the carrier, therefore all coverages for all employees are canceled.

The situation: The Alagassi Companies uses a broker for their insurance needs. The broker chooses where to submit the business — sometimes it is directly with the carrier, but many times there is a third party intermediary such as a wholesaler or a third party administrator.

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This month’s insurance nightmare: Your employer enrolled you on the company plan, but you did not receive the cards for two months and are not listed on the bill.

The situation: An employer named J.J. hired Bill on October 16. The waiting period established by J.J.‘s plan begins the first of the month following the hiring date of the employee. Therefore the effective date of Bills’ families coverage is November 1. However, Bill did not get an insurance card, and J.J.’s bill for November does not reflect the fact that Bill has been added onto the plan. Understandably, J.J. is upset because he does not want to pay for the month of November since Bill cannot use the company health insurance plan that month, as his coverage was not reflected on the November bill.

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This month’s insurance nightmare: Prescriptions can be more money if you use the prescription card versus buying the prescriptions at Walmart, Target or online sources.

The situation: Mrs. Mumsly, the wife and administrator of a Maryland doctor’s practice, emailed us recently to say how disappointed she is with the practice’s drug management program.

“As of May 1 they were charging $320 for a 90 day supply for a generic drug that could be obtained in a local store for $10 to $15,” she said. “We looked into it and could not find out if this was due to the deductible pending, a non approval of the prescription, or some other error. But we are definitely paying more for these drugs than we should be.”

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This month’s insurance nightmare: Linda is having surgery in the morning, but at 4 p.m. the night before she gets a call from her HMO requiring her to post a $400 advance deposit — or the surgery is off. What should she do?

The situation: Our client Linda was scheduled to have surgery using a surgical group that had negotiated fees with her HMO carrier. The evening prior to surgery, however, she was notified that she needed to post a $400 bond before the doctors would perform the procedure. She was told she needed to sign a form stating she would pay whatever fees the carrier would not pay to the doctor.

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This month’s health insurance issue: You do not receive your bill from the insurance carrier, but are responsible for the payment.

The situation: Claudia, a business owner who has HMO and PPO coverage for her employees, did not receive her bill for the PPO insurance. When she realized there was a problem, she called the carrier to find out what was going on.

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